<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">省市区:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="form-inline" data-toggle="cxselect" data-url="/assets/libs/fastadmin-cxselect/js/cityData.min.json" data-selects="province,city,area" data-json-space="" data-json-name="n" data-json-value="">
                <select class="province form-control" data-first-title="选择省">
                    <option value="">请选择</option>
                    <option value="{$row.province}" selected="">{$row.province}</option>
                </select>
                <select class="city form-control" data-first-title="选择市">
                    <option value="">请选择</option>
                    <option value="{$row.city}" selected="">{$row.city}</option>
                </select>
                <select class="area form-control" data-first-title="选择地区">
                    <option value="">请选择</option>
                    <option value="{$row.area}" selected="">{$row.area}</option>
                </select>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_code_lists_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay_code_lists_id" data-rule="required" data-source="pay/code/lists/index" class="form-control selectpage" name="row[pay_code_lists_id]" type="text" value="{$row.pay_code_lists_id|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
